If you are new to the forums, you must register a free account before you can post. The forums have a separate registration from the rest of www.chronofhorse.com, so your log in information for one will not automatically work for the other. Disclaimer: The opinions expressed here are the views of the individual and do not necessarily reflect the views and opinions of The Chronicle of the Horse.

I agree with most of what you said, except that. There are different costs of living and costs of doing business in different regions. The expenses of a doctor in Iowa are not the same as a doctor in CA. It may take them the same amount of time to diagnose a cold and they may buy bulk Band-Aids at the same price, but the cost of office space and employee wages are not going to be the same. Having the same premiums implies that reimbursement is the same. I doubt that many CA doctors could afford to work on IA rates.

Mmmmm This is true didnt realy think of that.. then a "happy medium" so to speak. But I dont think it is "fair" (and I hate that word) that just because people live someplace where the cost of liveing is higher that means thier colds etc are worth more..

this. Plus we pay out bucketloads of money trying to keep all the extremely premature/ born sick babies alive for some reason- if it's born too broke to fix, why? let it go immediately. And some of the other nasty birth defects, while the child is viable, perhaps we should consider euthanising it, in the name of being humane (to parents and child). Would also save a ton of money.

Most of our healthcare money is spent in the wrong place- fixing problems. If we spent money on preventing problems we'd spend a lot less. Most of our health problems of today are caused by poor diet, lack of exercise, and smoking. Yes, smoking. Still.

Healthcare should never be operated "for profit". Practitioners should be paid for their ability to keep their patients healthy, not on a per-procedure/visit basis, which encourages the heathcare system to let people get sick.

This makes way too much sense to ever be implemented. As a side note, when did dying become such a thing to avoid? I don't want to live for as long as possible, I want to have the best life possible.

this. Plus we pay out bucketloads of money trying to keep all the extremely premature/ born sick babies alive for some reason- if it's born too broke to fix, why? let it go immediately. And some of the other nasty birth defects, while the child is viable, perhaps we should consider euthanising it, in the name of being humane (to parents and child). Would also save a ton of money.

Most of our healthcare money is spent in the wrong place- fixing problems. If we spent money on preventing problems we'd spend a lot less. Most of our health problems of today are caused by poor diet, lack of exercise, and smoking. Yes, smoking. Still.

Healthcare should never be operated "for profit". Practitioners should be paid for their ability to keep their patients healthy, not on a per-procedure/visit basis, which encourages the heathcare system to let people get sick.

That was tried previously, with unforseen results.

I wasn't always a Smurf
Penmerryl's Sophie RIDSH
"I ain't as good as I once was but I'm as good once as I ever was"
The ignore list is my friend. It takes 2 to argue.

1)Revise the tort system for malpractice. Establish a court that only listens to malpractice cases...verdicts decided by judges versed in basic medicine, and put a cap on the awards.

2)All states should implement a Death with Dignity policy, allowing those terminal patients to elect to end their misery.

3) Allow people..from newborns to the elderly to die. Somehow we need to change the ethical thinking and guilt about doing everything to keep one alive. If we were able to establish the belief that it was OK to die, or to let someone die without guilt, I think we would begin to reverse the fact that most dollars are spent in the last 90 days of a patient's life.

4) Somehow put a cap on how much CEO's of insurance companies can make...Mandate that a high percentage of premium dollars be spent solely on medical care. (This may be part of the Obamacare).

this. Plus we pay out bucketloads of money trying to keep all the extremely premature/ born sick babies alive for some reason- if it's born too broke to fix, why? let it go immediately. And some of the other nasty birth defects, while the child is viable, perhaps we should consider euthanising it, in the name of being humane (to parents and child). Would also save a ton of money.

Most of our healthcare money is spent in the wrong place- fixing problems. If we spent money on preventing problems we'd spend a lot less. Most of our health problems of today are caused by poor diet, lack of exercise, and smoking. Yes, smoking. Still.

Healthcare should never be operated "for profit". Practitioners should be paid for their ability to keep their patients healthy, not on a per-procedure/visit basis, which encourages the heathcare system to let people get sick.

I pretty much agree with everything you're saying, particularly the idea that healthcare should not be "for profit." The preemie babies thing is a little harder to swallow though--how do you really draw that line? Lots of preemies would die immediately without months of access to incubators and other expensive emergency care. However, many if not most of them grow into healthy children with no lasting issues (I was one of those).

this. Plus we pay out bucketloads of money trying to keep all the extremely premature/ born sick babies alive for some reason- if it's born too broke to fix, why? let it go immediately. And some of the other nasty birth defects, while the child is viable, perhaps we should consider euthanising it, in the name of being humane (to parents and child). Would also save a ton of money.

Wow.

I was one of those premature babies (born at 24 weeks, 1 lb 9 oz). If it were not for the excellent care that I received at the hospital where I was born I would not be in the health or condition I am today. Occasionally I meet someone who knew my parents when I was a tiny baby and they are so happy to see me as a happy and healthy young adult. One of my brothers was also born premature. I am just shocked that you would insinuate that we no longer train doctors and nurses to treat and aid premmies...

However I do agree with you that preventative care is a must. Smoking may be a taboo in my generation now (at least that is how I see it) but there are still many people smoking. I'd also suggest more programs like the one that Jamie Oliver worked hard to implement on his show Food Revolution in schools..the way we feed our kids these days is absolutely shocking, school food and otherwise.

Mmmmm This is true didnt realy think of that.. then a "happy medium" so to speak. But I dont think it is "fair" (and I hate that word) that just because people live someplace where the cost of liveing is higher that means thier colds etc are worth more..

Compare health care to horse boarding and training. If the cost of living in a particular area, the cost of doing business (real estate, salaries, etc) is higher, well then of course, the cost of horse boarding or medical attention will be higher. Unless you know something I don't know.

This makes way too much sense to ever be implemented. As a side note, when did dying become such a thing to avoid? I don't want to live for as long as possible, I want to have the best life possible.

...You know, every time people say stuff like this, I assume they're cool with, next time they get a pretty severe illness, letting the disease run its course one way or another? Or when their elderly relatives get sick, they tell them not to waste money on treatment, they're old anyway. Heck, by that logic, why not just euthanize everyone at a certain age rather than spend millions every year on nursing homes? Those cost a fortune and really ramp up health care costs.

I don't have a problem with palliative care if that is what the PATIENT and their FAMILY want. I don't want doctors, bureaucrats (which is what it comes to if you let civil servants run the health-care system, as it DOES keep costs down to kill things instead of treat them), or people who think they know what is best determining what care is administered in a broad sense-"Well, *I* wouldn't want to live as a quadriplegic, so NO ONE would, so we won't pay to keep someone with a major spinal injury alive because they'd just have bad quality of life and die anyway."

Also, people who are in favor of abortion, birth control, and euthanizing babies rarely seem to make the leap to cheaper, more logical options--outlawing fertility treatments in all cases, outlawing surrogacy, and probably the biggest cost-cutting measure, eliminating birth-control funding in favor of sterilizing people, which is cheaper short term and keeps costs down in the long run

And if you're going euthanize premature babies who might have long-term problems, what about babies with Downs Syndrome? They're going to cost the health-care system a fortune and they're not going to live as long--should parents be REQUIRED to abort them (or any other babies who test for defects)? That will save a lot of money. Or, should people carrying known defective genes, or if you allow them to live those Downs patients, or others with developmental issues, have to be sterilized to prevent future expensive pregnancies and defective offspring? Are three generations of idiots enough after all?

And what about unnecessary expensive procedures? If spending a fortune to keep someone alive who isn't deemed worthy is too expensive, what about things like cosmetic surgeries? Heck, what about sex changes? Should THOSE be covered, even though they serve no medical purpose, cost a lot, and can lead to more medical problems from post-surgical complications? There's no medical or biological reason to alter the genitals of someone with an XY chromosome to look like those of a person with an XX. What they THINK is beside the point to what biologically exists. And someone who really has a sex-chromosome abnormality (an XXY, intersexed, androgen insensitivity) is another expensive baby that really shouldn't have been allowed to live under the 'euthanize preemies and abnormal offspring' logic, as even if immediate care isn't going to be as high, someday they WILL cost the system money.

However I do agree with you that preventative care is a must. Smoking may be a taboo in my generation now (at least that is how I see it) but there are still many people smoking. I'd also suggest more programs like the one that Jamie Oliver worked hard to implement on his show Food Revolution in schools..the way we feed our kids these days is absolutely shocking, school food and otherwise.

I hate Jamie Oliver, as he is not a trained nutritionist and often way oversteps his role as a cook, but I loved what he did in Huntington with one exception. Removing chocolate milk from schools doesn't make kids drink white milk. It just means that they miss one of the most nutrient dense foods they are likely to get. And yes, it may have a couple spoonfuls of sugar, but these kids are guzzling Mountain Dew and Red Bull before and after school. That chocolate milk is likely the healthies thing they consume, when you consider the carb loaded sodium filled school lunches offered. It would cost school districts a fortune to replace the nutrients found in one serving of chocolate milk. They would need to serve melon, tuna and edamame to hit all the missed vitamins and minerals, in addition to the regular meal.

What I found really sad was the one little girl shown whose mother had packed her a couple baggies of brightly colored sugared cereal and some chips because she would not eat the healthy meal offered by the school. Until parents are willing to take responsibilty for actually raising their children, paying attention to exercise, diet, mental health, etc, preventative health care isn't really going to matter.

I work in an emergency room in NYS and I will share some things I've noticed over the years:

1) It's illegal for a non-profit hospital to deny someone care, regardless of the complaint or how often they have been there that one day already. Yes, I've personally taken care of patients on THREE separate visits across my 8-hr shift. They are not the majority but they do add up... especially when they take an ambulance BACK to the hospital for each visit.

2) Ambulances are like taxis in this city. Families who do not have cars struggle to use the bus system because it either doesn't go where they need to go, or it goes on on inconvenient time, or they simply can't manage to get 4 kids under the age of 10 safely across town by that mode. An ambulance is a safe, door-to-door trip for the sore throat. If the law would let ambulances take people to clinics, it might help. Or, since medicare/medicaid pays for taxis home from the hospital, they should have a car service that picks people up to go TO a clinic (like you would call for an ambulance, with similar prompt response time). People I know have tried to take a taxi to the ED but they were told it would be an hour before they could be picked up and for whatever reason that wasn't going to work for them. It could also help to have clinics set up next to EDs so a triage nurse and/or attending doc could do a quick once-over and push them down the hall to the clinic setting. In the event someone DID have a serious issue that went unnoticed in triage, it would be quick and easy to bring them back to the high level of life-saving care.

3) Our county is doing a really big push for ALL doctors to have end-of-life care convos with their patients in outpatient and inpatient settings, at all ages. Real discussions of what EOL care looks like, what they might expect, the ups and the downs. And then giving people the paperwork to fill out, take home think it over, talk about it, etc. The MOLST (methods of life sustaining treatment) allow you to specify your wishes about respirators, tube feedings, pain meds, etc. It's brilliant. And can be revoked or amended at any time by you, no doctor note necessary. You keep it on your fridge and the local EMS knows to look for it and bring it to the hospital. It's a great way for people to make informed choices. And it allows people who never thought about it, but do have a preference, to make it known. As a result of this, my personal, non-statistical non-representative experience has been an uptick in the number of patients who are declaring that only comfort-measures be implemented in the event they are incapacitated. There is also room on the forms to write "if... then... " things (like, "If I won't be able to walk again, I do not want life sustaining measures" or "If I will have any mental quality of life, I want to have life sustaining measures even if I can't walk ever again". In the first example, the patient won't "be killed" just because he can't walk, they simply won't put him on a respirator and be given tube feeds if he should fall unconscious for a long period of time).

Get rid of Medicaid and Medicare and come up with something cheaper, with less paperwork, and with a much more limited pool of users (only people who actually cannot be cared for in any other way--I do not want to have Medicare when I get old just because some idiot decades before I was born assumed I'd be too stupid to take care of myself.)

First step is to eliminate the separate billing companies that go between the patient and Dr.s. They are the ones responsible for things like billing one doctor for 200 hours a day. I know a guy that owned a medical billing company. He was worried about things going downhill, so he sold the whole company-for something like 100 million dollars. Why would an accounting business be worth a quick turnover of that sort of money?

The part below I've copied and pasted from another thread that I answered in.

But on her specific facts, it may have been irrelevant if the deductible had been almost as much as the surgical cost. I am Canadian and I dont pretend to understand all of this but what happens in such a case? If one has insurance with a high deductible, does the insured pay the deductible up front to the hospital and then the insurer pays the rest? If so, OP still would not have gotten the care she needed in a timely manner.

My response to the above quote:

I can answer this because we have personal experience with it. My wife had breast cancer. Stage 1, very early caught, simple surgery, chemo and radiation, 7 years ago, total cost 32,000 after it was all over. Cancer free since. Our health insurance was costing us less than 200 a month with 10,000 deductible.
We had to pay the 10,000 up front before they would even do blood work. Or rather, what was left of the 10,000 after we had paid for previous tests and Dr.'s visits up to that point. We even had to make a special trip to make the payment, so they could check that everything was clear before they proceeded.

Every year after that, our monthly insurance premium went up to the point 7 years later was 1018 plus change each month. If we had ever missed a payment, they would have dropped us in a heartbeat. Now we are well off enough that we can weather about anything that happens to us medically, but we would be out on the streets in a few years. Fortunately, we are old enough that we would have some income from Social Security after those few years and medical care by Medicare-another program that half the country didn't want to "pay for" back when it was first being planned.

Under Obamacare, since they can no longer factor pre-existing conditons, our monthly cost is 269 with the same 10,000 deductible.

Some say they shouldn't be paying the difference for us.

Romneycare, that he had the same people come up with that Obama got to prepare the original Obamacare package, worked because it has the mandate. Without the mandate, it is still an incomplete package. The mandate was filibustered out. Why do so few people understand this???? There can be no across the aisles anything, as long as either side has one answer for anything-No. Please check how much time is wasted by the current filibuster methods.

When you force insurers to accept everyone, without forcing healthy people to buy insurance, you encourage people to go without insurance when they're healthy, and buy it as soon as they get sick. The pool of the insured gets sicker and sicker, premiums rise higher and higher, this in turn makes healthy people even more reluctant to buy insurance, and ultimately you end up with middle-class people unable to afford insurance at all. This, in fact, is what has happened in every state that has tried guaranteed issue without a mandate, which is why Mitt Romney enthusiastically included a mandate when he created a universal health-insurance system in Massachusetts.

Those who say they don't want to pay extra for someone who gets sick must be really simple minded. Maybe had their intelligence dulled by listening to too much propaganda TV. Maybe they are absolutely sure that they will never get sick or injured to the point that an insurance company could keep going up on their premium to the point that either they couldn't pay it, or if they missed a payment they could be dropped. I don't understand how any person of average intelligence feels that was a good system. Not a single one of my smart friends, who are a lot smarter than I am, believe that the old system was anything but stupid.

We are the only modern country in the world who has not figured this out. It's really disappointing, but the main problem in the world is average intelligence level, balanced against mainly greed.

Let's get it done, behind us, and get on to other things. Vote the obstructionists out of office.

Simple. Allow purchasing insurance across state lines. I resent paying outrageous premiums in my state b/c others choose not to get insurance. We are like fish in a pond for ins. companies; they can charge higher rates here b/c of the number of illegal and indigent people. And by keeping rates within state lines ins. companies can charge what they want.
More competition means competitive rates.

It's only when a mosquito lands on your privates that you realize there is always a way to solve problems without using violence. fb meme.

1) remove the anti-trust protections. This would allow people to purchase insurance across state lines, and offer true competition. Bring on the Sherman ACt lol.

2) Tort reform. Interestingly, my state, Massachusetts has implemented a med mal tribunal. Med mal complaints/litigants first go before the tribunal before the case can go to trial. I don't do med mal, nor have I been on the other side so I don't have first hand experience on how it works, but its been around for a few years here.

There are little things (well big things) that can be done here and there, but the real problem is people have to get over their fears about socialized medicine.

People don't want to pay for other people's care. What do you think is happening now? Somebody pays for that care and it is in a very inefficient way. There are lots of cases of a simple illness caught early that would have been cheap to treat, but due to lack of affordable healthcare, a simple illness turned into > 100K hospital bill that someone is going to have to cover.... That someone is all of us. That is very inefficient. Provide basic health care to people. Keep them from using the emergency room as a free clinic. Get them in for well care and monor issues before thay become major.

Quit screaming about paying for everyone elses health care, you already do! Those emergency room visits are just put into fees paid by the rest of us.

Quit worrying about rationed care. Unless you pay all of your own bills, your current care IS determined by a bean counter. Insurance companies are for profit. They determine whether or not you can have a procedure. The have all kinds of exclusions. Should insurance pay for everything? Probably not. They should follow the guidelines of good medicine (determined by medical providers). Do we need guidlines? Yes, we probably do, to contain costs.

Quit screaming about "death panels" End of life counseling is NOT a death panel....

Quit practicing defensive medicine. Use some common sense. You don't need to use every expensive tool in the arsenal to make a diagnosis.

Ways to save money:

Support medical education so Drs can make a living instead of paying off student loans.

Think about current malpractice issues. This is difficult because there should be some way to recover damages when actual malpractice occurs, but we do need to put a lid on it.

I don't think we can institute policies on premies or elderly etc, because those decisions are way too personal to mandate. But education can go a long way. Counseling for elderly and terminal patients, let them know their options. And then having the decisions of those patients be honored. I know of a number of cases where DNR or no excessive measures requests were ignored. Honor the patient's choice.

It is incomprehensible that this country can not seem to get a reasonable health care system in place.

3. Allow insurance companies to refuse to cover injuries stemming from the patient's own negligent choices (i.e. a car accident if they were not wearing a seat belt, riding/bike/motorcycle accidents if they weren't wearing a helmet (and leathers if a motorcycle), issues stemming from drinking while pregnant or injuries stemming from drinking/drugs and doing anything, etc. Yes, insurance does and should spread the risk, but people need to assume some personal responsibility for their activities as well. I don't have a problem paying my premiums knowing someone will get, say, breast cancer treatments partially on my dime, but I do have a problem paying for the ignorance and selfishness of others.

3. Allow insurance companies to refuse to cover injuries stemming from the patient's own negligent choices (i.e. a car accident if they were not wearing a seat belt, riding/bike/motorcycle accidents if they weren't wearing a helmet (and leathers if a motorcycle), issues stemming from drinking while pregnant or injuries stemming from drinking/drugs and doing anything, etc. Yes, insurance does and should spread the risk, but people need to assume some personal responsibility for their activities as well. I don't have a problem paying my premiums knowing someone will get, say, breast cancer treatments partially on my dime, but I do have a problem paying for the ignorance and selfishness of others.

And just how do you enforce that. Do you leave the guy without the helmet in the road to die?